The American Health Care Act (AHCA) passed the House in the face of opposition from physicians, hospitals, and insurers. But that opposition was muted and it failed to defeat the bill. This is mysterious because amid other provisions the bill cut more than $800 billion from Medicaid funding. That money would make a real difference for many doctors, hospitals, and Medicaid Managed Care plans (to say nothing of disabled people or poor people currently receiving Medicaid). There’s an explanation for this meek opposition in Robert Pear’s article in the New York Times.
First, let’s revisit how fiercely some of these groups resisted previous health care legislation. It’s often thought that the Health Insurance Association of America’s ‘Harry and Louise’ ad helped defeat the Clinton health care plan of 1993.
So why aren’t these interest groups on the barricades this time? One reason, as Pear explains, is that no one in the Senate takes the House bill seriously.
Reince Priebus, the White House chief of staff, has said he expects the Senate to make improvements in the repeal bill that the House passed last week… But senators have gone much further: The Senate is starting from scratch.
“Let’s face it,” Senator Orrin G. Hatch of Utah, chairman of the Finance Committee, said Monday. “The House bill isn’t going to pass over here.’’
Hospital executives, among the most outspoken critics of the House bill, are in town for the annual meeting of the American Hospital Association and will lobby the Senate this week. Thomas P. Nickels, an executive vice president of the association, predicted that the Senate would produce an “utterly different version” of the legislation.
So that’s why the resistance was muted: the relevant interest groups were told not to worry about what was in the AHCA. The House vote was just for… what? To save the President and Speaker Ryan from the humiliation of being unable to pass anything?
Of course, if the Senate is starting from scratch, it means that the Republicans still have no idea what their design for replacing the ACA is. Moreover, if the Senate does draft new legislation, what is the magic that will make the Senate bill the real bill? Suppose the Senate drafts and passes a significantly more moderate bill. Then that bill, or a House-Senate compromise bill, will have to be passed by the House. What happens to the delicate compromise between conservative members and radically-conservative members that was required to pass the AHCA through the House? Will the Senate bill be dead on arrival at the House?